Pre Screening Form | Life Anchored Coach

We are here to help anchor you
with 1:1 coaching services.

The first step is to complete this brief confidential pre-screening form. This helps us understand your needs and to be sure that coaching is the right fit for your situation; it should take about 5 minutes to complete.

*Required responses. Please write N/A if not applicable.

Name of person completing form

Phone

Please indicate what type of coaching you are interested in

Adult coaching

Parent coaching

College student coaching

Coaching for child/teen

If you have a child you are seeking coaching for, please list their age and grade:

Briefly explain why you are reaching out for coaching. What are the specific struggles you (or your child) are experiencing?

Have you (or your child) been diagnosed with ADHD? (A diagnosis is not necessary for coaching)

Do you (or your child) have any other mental health diagnoses or learning disorders?

Are you (or your child) currently taking any medication for ADHD or any other mental health diagnoses?

Are you (or your child) currently in therapy or have you (or your child) previously received therapy?

How open is your child to the idea of coaching? If you have a teenager, we would encourage you to discuss coaching with them to see if they are open to it; if they are not wanting coaching, we encourage parent coaching instead. (write N/A if not applicable) - If applicable, are you open to parent/family coaching?

Are you wanting

in-person coaching (Northern VA only)

virtual coaching

open to both

Where are you located? (Town, State, Country)

Would you like to be added to our contact list for future parent/adult group coaching opportunities and study skills workshops?

After pressing submit, you will find in your inbox, a short introductory video and next steps, should you decide to move forward with a pre-screening call. Please check your spam folder if you don't receive an email in the next 5 minutes or contact info@lifeanchoredcoaching.com and let us know. We will respond as soon as possible!

Thanks for submitting!

We are here to help anchor you with 1:1 coaching services.

We are here to help anchor you
with 1:1 coaching services.